Abstract

To the editor: Bayer (Ann Intern Med 85:475-476, 1976) has described miliary pulmonary infiltrates as a previously unreported manifestation of Dilantin® (phenytoin) toxicity. We recently saw a patient with Dilantin toxicity whom we found to have multiple noncaseating bone-marrow granulomata, which to our knowledge has not been described as a manifestation of this disorder.

The patient, a 34-year-old alcoholic, diabetic, black man was admitted to Middlesex General Hospital, with diarrhea, rash and lymphadenopathy of 1 to 2 weeks duration. Four weeks after Dilantin was started for a seizure disorder. Bone-marrow aspiration and biopsy showed multiple noncaseating granulomata. A bone-marrow specimen